Diagnosis of the pancreas

Patients with pancreatic diseases can make complaints about abdominal pain, as well as dyspepsia, general weakness.

Complaints

Pain in the abdomen, quite diverse in duration and nature, are localized most often in the upper half of the abdomen, mainly in the epigastric region or the left hypochondrium, radiating into the back. They can be acute, intense, shingles, with irradiation in the lumbar region, which in acute pancreatitis is associated with a violation of outflow of secretion from the pancreas and the action of their own proteolytic enzymes. Long and intense pains are characteristic of tumors; they often increase in the position of the patient on the back, which forces the patients to take a half-bent position.

Dyspeptic phenomena, nausea, vomiting often occur with various pancreatic diseases as a result of changes in its enzymatic activity or reflexively.

Mechanical jaundice with pruritus of the skin is characteristic for the defeat of the head of the pancreas with violation of the outflow of bile.

[1], [2], [3], [4], [5]

Physical methods of pancreas research

On examination, exhaustion, jaundice with its characteristic consequences in the form of scratching, hemorrhage is revealed. Palpation of the pancreas remains an ineffective method. Only with a marked increase in the gland due to tumor lesion with deep sliding palpation can detect neoplasm.

Additional methods of pancreas research

Laboratory and instrumental methods allow to more accurately detect the active destructive process in the gland; evaluate residual exocrine pancreatic function; evaluate the endocrine function of the pancreas and evaluate the morphological features of the gland.

Radiographic examination of the pancreas. A survey X-ray of the abdominal cavity can detect calcifications in the gland. When barium contrast is introduced, indirect signs of inflammatory and neoplastic processes in the proximal part of the pancreas can be obtained, taking into account changes in the mucous membrane of the duodenum.

Ultrasound examination of the pancreas. This non-invasive and safe method can detect cysts and neoplasms in the pancreas, and also determine its increase as a result of edema or densification (fibrosis).

Computer tomography. In patients with obesity and intestinal obstruction, ultrasound is usually difficult, so it is advisable to conduct a computer tomography, which also allows you to assess the morphological changes in the gland, identify a tumor, cyst, inflammation, edema.

Angiography of the arteries of the pancreas. Selective angiography of the arteries, supplying the pancreas with blood, is suitable for diagnosing tumors. It allows you to detect a narrowing of the lumen of the vessels and a violation of their position. Usually this research is carried out after ultrasound and computed tomography.

Endoscopic retrograde cholangiopancreatography. This study is considered one of the most valuable methods of visualization of pancreatic and bile ducts. Through the endoscope, a contrast iodinated substance is injected into the common bile duct and then X-rays are performed, which allows not only to establish the cause of mechanical jaundice, but also to detect pancreatic changes characteristic of the inflammatory and neoplastic processes. With chronic pancreatitis, the duct can be deformed, and sections of constriction and expansion can be seen. If there is a tumor, isolated duct stenosis or complete obstruction can occur.

Radioisotopic examination of the pancreas. This study of the pancreas using methionine labeled with radioactive isotope selenium is generally significantly less accurate than the listed methods of investigation.

Study of pancreatic enzymes in blood and urine. Necrosis of pancreatic tissue as a result of obstruction of the duct of the gland can be estimated by increasing the concentration of pancreatic enzymes in the blood, urine and other body environments. The most common measurement of the activity of amylase and lipase. During acute pancreatitis, the elevated serum amylase level persists for up to 10 days and is usually accompanied by hyperamylasuria. An increase in the content of amylase in serum and urine takes place not only in pancreatitis, but also in the pathology of the biliary tract, perforation of the stomach ulcer, intestinal obstruction, and some viral diseases, which is apparently associated with concomitant pancreatic disease.

Due to the fact that amylase enters the blood not only from the pancreas, but also from the salivary glands, attempts are being made to determine its isoenzymes. Using radioimmunoassay, the serum activity of other enzymes, trypsin, lipase, elastase, is evaluated.

Research of the pancreas function. The exocrine function of the pancreas is assessed by direct and indirect stimulation. Direct stimulation consists of parenteral administration of a number of hormones, in particular secretin and cholecysto-kinin, as well as their combinations. Indirect stimulation is the ingestion of nutrients. In both cases, measurement of pancreatic enzymes - amylase, trypsin, lipase (the concentration of which under the influence of secretin initially decreases slightly and then increases) in duodenal contents, which is obtained with a probe. An additional and important method for assessing the exocrine function of the pancreas is to study feces in order to determine the content of fats and protein products in it.

Quantitative evaluation of the fat content in fecal masses, as well as chymotrypsin and trypsin, allows to detect a progressive decrease in the function of the gland quite accurately.

The test for glucose tolerance makes it possible to evaluate the endocrine function of the pancreas, which is disturbed in 3/4 patients with pancreatitis or with a pancreatic tumor.

Examination of the function of the pancreas, especially exocrine, is important in patients with impaired absorption to clarify the cause of this pathology and, in particular, to determine the role of reducing pancreatic function.

[6], [7], [8], [9], [10]